Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique

Ceccaroni, Marcello; Clarizia, Roberto; Alboni, Carlo; Ruffo, Giacomo; Bruni, Francesco; Roviglione, Giovanni; Scioscia, Marco; Peters, Inge; Placido, Giuseppe De; Minelli, Luca

doi:10.1007/s00276-010-0624-6

Cited by 63 publications

(37 citation statements)

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“…The surgical anatomy, feasibility, and effectiveness of the nerve-sparing technique for laparoscopic eradication of deep endometriosis with segmental bowel resection performed at our institution have been previously described in literature [1][2][3][4]7]. The goal of the nerve-sparing approach is to better identify the visceral neural fibers and surgical landmarks, thereby improving the dissection of the vascular portion (pars vasculosa) from the neural portion (pars nervosa) of the parametrium.…”

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confidence: 98%

“…These symptoms are due to deep infiltration of the rectovaginal septum, pelvic ligaments, and viscera (uterosacral ligaments, rectovaginal ligaments, lateral rectal ligaments, cardinal ligaments, vesicouterine ligaments, rectum, vagina, bladder, and ureters) and posterior and lateral pelvic wall, close to the visceral and somatic pelvic nerves. Different typologies of pelvic pain are commonly evaluated with Visual Analogue Scales [1][2][3][4][5][6][7][8][9]. Neurologic pain is related to visceral and neural infiltration of the disease and in some cases to its compressive effect on the pelvic wall [3,4,[8][9][10].…”

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confidence: 99%

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Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial

et al. 2012

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Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial

et al. 2012

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“…Endometriosis occurring solely along pelvic nerves, such as the sciatic and obturator, causes a similar constellation of cyclic symptoms but without the back pain, and is much more common than intramedullary endometriosis. 6,10,11,14,16,18,28,29,35,38,40 Imaging of the spine shows an intradural mass lesion suggestive of a well-circumscribed tumor or hemorrhagic cyst, but is nondiagnostic.…”

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Endometriosis of the conus medullaris causing cyclic radiculopathy

Steinberg¹,

Gonda²,

Muller³

et al. 2014

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Intramedullary spinal cord hematomas are a rare neurosurgical pathological entity typically arising from vascular and neoplastic lesions. Endometriosis is an extremely rare cause of intramedullary spinal cord hematoma, with only 5 previously reported cases in the literature. Endometriosis is characterized by ectopic endometrial tissue, typically located in the female pelvic cavity, that causes a cyclical pain syndrome, bleeding, and infertility. In the rare case of intramedullary endometriosis of the spinal cord, symptoms include cyclical lower-extremity radiculopathies and voiding difficulties, and can acutely cause cauda equina syndrome. The authors report a case of endometriosis of the conus medullaris, the first to include radiological, intraoperative, and histopathological imaging. A brief review of the literature is also presented, with discussion including etiological theories surrounding intramedullary endometriosis.

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“…Gastrointestinalis lae siók az esetek 5,3-12%-ában jelennek meg [1,4,5,6,7]. A DIE érintheti a kismedence elülső régióját is, jelentkezhet a plica vesicouterinán és infi ltrálhatja a húgyhólyag izomzatát.…”

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Az idegkímélő műtéti technika jelentősége a mélyen infiltráló endometriosis sebészetében

et al. 2015

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Bevezetés: A mélyen infi ltráló endometriosis kezelésében az elváltozások hagyományos sebészi eltávolítása súlyos szö-vődményekkel járhat. Célkitűzés: Idegkímélő, illetve hagyományos technikával végzett műtétek összehasonlítása, az egyes szövődmények előfordulási gyakoriságának ismertetése mélyen infi ltráló endometriosissal foglalkozó munkacsoportok műtéti eredményeinek összefoglalásával. Módszer: A szerzők retrospektív elemzést végeztek a 2004. már-cius 31. és 2015. március 31. között megjelent tudományos közlemények felhasználásával. A keresést a http://www. pubmed.org adatbázisban végezték az "endometriosis", "deep infi ltrating," "nerve-sparing, surgery" (endometriosis, mélyen infi ltráló, idegkímélő, sebészet) keresőszavak kombinációjának alkalmazásával. Eredmények: Mélyen infi ltráló endometriosis kapcsán végzett, nem idegkímélő beavatkozásokat követően 19,1-38,5%-ban jelentkezhet átmeneti húgyhólyag-diszfunkció, míg idegkímélő műtéti technika alkalmazását követően a betegek 0,61-33,3%-ában fordulhat elő. Nem idegkímélő technika alkalmazását követően a betegek átlagosan 121,1 napig, idegkímélő műtéteket követően 7-39,8 napig szorultak önkatéterezésre. Krónikus húgyhólyag-diszfunkció mélyen infi ltráló endometriosis miatt végzett idegkímélő műtéteket követően nem fordult elő. Következtetések: Az idegkímélő technikák alkalmazása a betegek életminőségének jelentős javulását eredményezi, mivel panaszaik kezelése mellett alacsonyabb poszt operatív szövődményrátával társul. Orv. Hetil., 2015Hetil., , 156(48), 1960Hetil., -1965. Kulcsszavak: nőgyógyászat, műtét, endometriosis, neurogén húgyhólyag-diszfunkció Importance of nerve-sparing surgical technique in the treatment of deep infi ltrating endometriosisIntroduction: Traditional surgeries performed in cases of deep infi ltrating endometriosis lead to impaired quality of life. Aim: To summarize the postoperative outcome and to compare the rate of postoperative complications after different therapeutic approaches applied in deep infi ltrating endometriosis. Method: The authors analized the articles published between March 31, 2004 and March 31, 2015, in the database www.pubmed.org using the following keywords: endometriosis, deep infi ltrating, nerve sparing, surgery. Results: Non-nerve sparing surgery resulted in temporary urinary dysfunction in 19.1-38.5% of patients, while it occurred in 0.61-33.3% of patients after nervesparing surgery. Non-nerve sparing surgical technique resulted in an avarage of 121 days of need for self-catheretisation. When nerve-sparing surgeries were performed the duration of self-catheterisation varied between 7 to 39.8 days. After nerve sparing surgeries, permanent bladder dysfunction was not detected in any case. Conclusions: Because of the successful treatment of the patients symptoms and the lower postoperative complication rate, nerve-sparing surgical technique leads to a signifi cant improvement of the quality of life.

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Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique

Abstract: Laparoscopic transperitoneal retroperitoneal nerve-sparing approach to the pelvic wall proved to be a feasible and useful procedure even if limited to referred laparoscopic centers and anatomically experienced and skilled surgeons.

Cited by 63 publications

References 11 publications

Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial

Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial

Endometriosis of the conus medullaris causing cyclic radiculopathy

Az idegkímélő műtéti technika jelentősége a mélyen infiltráló endometriosis sebészetében

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